Provider Demographics
NPI:1225479579
Name:NELSON, ANDREA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SW PARK STREET
Mailing Address - Street 2:OKEECHOBEE DISCOUNT DRUGS
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972
Mailing Address - Country:US
Mailing Address - Phone:863-763-5100
Mailing Address - Fax:863-763-8556
Practice Address - Street 1:203 SW PARK ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4160
Practice Address - Country:US
Practice Address - Phone:863-763-5100
Practice Address - Fax:863-763-8556
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT35394183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician